UNDESIRABLE INCIDENT NOTIFICATION FORM

Explanations:
* The "describe event" section on the notification form is mandatory and the other two sections are optional.
* Only information about the subject and the event should be included, regardless of the name of the employees, staff and patient.
* No identifier should be used for the names of employees and patients involved in the incident.
* The name of the department or unit where the event took place and the date and time of the event should not be written on the form.
* The notification forms will be evaluated by the Quality Management Unit for compliance with the rules.
* Forms with the name of the patient and employee and / or descriptive will not be considered.
* The forms with the name of the department or unit where the event took place and the date and time of the event will not be evaluated.
* Notifications submitted by the Quality Management Unit in accordance with the rules should be forwarded to the Patient and Employee Safety Committee.
* The event must be explained in the statement of the notifier.